Bronchial asthma and hypovitaminosis D in Saudi children

BACKGROUND: Asthma, a common lung disease in children, is caused by excessive immune responses to environmental antigens. OBJECTIVE: Given the immuno-modulatory properties of vitamin D, the aim of the current study was to investigate the relationship between vitamin D levels and markers of asthma severity. METHODS: This was investigated in a 70 Saudi children with and without asthma and were recruited from the King Abdul Aziz University Hospital, Jeddah, Saudi Arabia, over the period of 11 months (May 2011-April 2012). Childhood asthma control test instrument was employed to assess the level of asthma control among asthmatic patients. Anthropometric measurements were taken and interviewer-administrated questionnaire was completed for all study participants. Pulmonary function test was performed by recording changes in the peak expiratory flow. Venous blood samples were withdrawn for measurements of vitamin D, bone profile, cytokines profile (interleukin-10, tumor necrosis factor-alpha, platelets derived growth factor), and atopy markers (IgE and eosinophil count). RESULTS: Hypovitaminosis D is highly prevalent among asthmatic children with highly significant increase in several markers of allergy and asthma severity as compared with healthy control children. Significant correlations between several inflammatory and immunological markers and vitamin D levels were also found. Finally, lower 25-hydroxyvitamin D levels were associated with a higher asthma prevalence in multivariable analysis. CONCLUSION: Our study showed that hypovitaminosis D is highly prevalent in the whole population in addition to a highly significant increase in several markers of allergy and asthma severity among asthmatic children as compared with healthy control children.

Mini-incision living donors nephrectomy using anterior muscle-splitting approach with hybrid technique

Significant morbidity is associated with standard open flank living donor nephrectomy. Laparo- scopic donor nephrectomy is criticized for a steep learning curve and a tendency to avoid the right kidney. The anterior muscle-splitting technique uses principles or advantages of an open extraperitoneal approach with minimal morbidity and the advantageous muscle-splitting [instead of cutting] procedure. To compare mini-incision laparoscopic instrument-assisted [MILIA] live donor nephrectomy using a muscle-splitting technique to the standard open-flank donor nephrectomy [ODN] approach for efficacy and safety. MILIA living donor nephrectomies were performed in 119 donors and compared to a cohort of open-flank nephrectomy donors [n=38] from the same center. Both donor groups were matched for body mass index as well as other personal characteristics. The mean donor age was 35 [range: 18-60] years. The right kidney was procured in 28% of cases. The majority of donors were female [58%] and Caucasian [60%]. No differences were observed between MILIA and ODN donors for the age, gender and ethnicity. However, MILIA donors experienced a longer mean_SD operative time [234 +/- 47 vs. 197 +/- 33 min, p<0.0001] but a shorter hospital stay [4 +/- 1 vs. 6 +/- 3 days for the ODN group, p<0.0001] and less intraoperative blood loss [215 +/- 180 vs. 331 +/- 397 mL, p<0.02]. No difference was found in the number of units of blood transfused [0.13 +/- 0.6 vs. 0.34 +/- 1.0 units, p=0.13]. Right-sided kidneys were almost equally harvested in both groups [29% of MILIA donors vs. 26% of ODN donors]. Post-operatively, MILIA donors had a significantly lower mean pain scores at one week and one month after surgery [p<0.001]. They showed significant better post-operative recovery earlier stopping of pain medications and restoration of other preoperative activities. Moreover, they were better satisfied with their scar appearance. Scores on the short form-36 quality of life questionnaire were comparable for both groups. MILIA is a viable option as an alternative for pure laparoscopic donor nephrectomy. MILIA ap- pears to be as safe as open donor nephrectomy and may provide advantages over ODN, such as smaller incision, shorter hospital stay, and less incisional pain. Patient recovery and satisfaction after MILIA are excellent. This technique avoids the possibility of adhesive intestinal obstruction and also improves handling of major complications [e.g., bleeding] of laparoscopic donor nephrectomy. Utilization of this hybrid tech- nique is particularly feasible on smaller [BMI<24 kg/m[2]] and medium-sized [BMI<28 kg/m[2]] donors. We believe that this technique should be adopted by centers that have limited advanced laparoscopic surgical experience and also it could be used selectively for the right donor nephrectomies, even in centers perform- ing hand assisted donor nephrectomies by including a small patch of inferior vena cava for a better quality of right donor kidney during transplantation

Detection of E. histolytica, G. lamblia and Cryptosporidium copro-antigens in stool samples

A double antibody sandwich ELISA technique using a chromatography purified anti sera against E. histolytica, G. lamblia and Cryptosporidium antigens was applied to detect coproantigens of the corresponding parasites in 90 patients. All positive cases were diagnosed by a parasitological examination and proved to have the infection. In addition to the 90 positive cases, 30 age-matched controls were included in the study, of which 20 individuals were infected with other parasites, but not Cryptosporidium, E. histolytica or G. lamblia [acted as an infected control group] and the other 20 individuals with no intestinal parasites [normal control group]. The assay could detect 100% of those infected with both of G. Lamblia and E. Histolytica and 96.6% of patients with Cryptosporidium infection. False positive reactions were detected in three cases using G. lamblia antisera [92.5%], five cases using E. histolytica antisera [87.5%] and two cases using Cryptosporidium antisera [95%]. A direct increase in the mean antigen level was observed with the increasing intensity of infection in the three parasites; so, higher mean OD reading was observed in the heavily infected cases than the moderately infected ones than lighter intensity of infection. Only those in the elder age group [>20 years] infected with E. Histolytica had statistically higher OD readings of the antigen than the middle age group [10-20 years]. On the other hand, no statistically significant difference was observed between the different age groups and antigen level in cases with either G. lamblia or Cryptosporidium